At
Large
Down there
April 14, 2005
By
Doug Cabral
There are a
bunch of questions that come to mind when the doctor says, as he
said recently to me, You know, you ought to have a colonoscopy.
Colonoscopy is the best screening test for colorectal cancer, a
malignant disease that this year will afflict 135,000 Americans.
It's the second leading cause of cancer-related deaths. In 2004,
according to Centers for Disease Control estimates, nearly 57,000
died of colorectal cancer, more than 90 percent of them men over
50.
Still, the first question that occurred to me was, Is there some
way to get out of this?
I don't have any worrisome symptoms, doc, you said so yourself.
I'm generally healthy. No history in the family. Maybe I'll do it
next year.
Well, doc says, at your age, even with no symptoms, the test is
indicated. If it's found early, the chance of successful treatment
of the cancer increases. When there are symptoms, treatment is less
promising. Have the test. Ten years later have another. It generally
takes ten years for the cancer to develop. And you'll probably need
ten years to get over the test.
But, how about the risks, says I. I could expire under anesthesia.
It's a risk, sure, says doc, but it's slight and manageable. You've
got life insurance. And, believe me, colon cancer means big trouble.
So, how is it done, I ask, pro forma, not really wanting to hear.
Colonoscopy is a way of checking the lining of the colon for problems
such as bleeding or polyps or cancer. It is the method of choice
for screening patients at high risk for colon cancer.
Hold on, I'm not high risk, am I?
You're getting older. I'm afraid your age elevates your risk profile,
doc says quietly. Anyway, the surgeon uses a colonoscope, which
is a long flexible, tubular instrument that he introduces into the
rectum.
Introduces, eh, says I, my keen literary senses instantly recognizing
a euphemism - and a particularly ghastly one - when I hear it.
Yes, and the other end has video so the surgeon can inspect the
lining of the colon directly. He might need biopsy forceps for certain
surgical procedures, but he can pass them through the colonoscope.
All right, that's enough, how much does it cost? (I know all the
stuff about good health being priceless, about how if your have
your health you're a rich man, about how chronically ill rich men
are always saying they would impoverish themselves if only they
could draw one healthy breath, but down here on earth, living in
the day to day with the rest of the plebes, I want to know, What'll
it cost?)
Now, for discussion purposes, I'm going to assume that a colonoscopy
is a colonoscopy is a colonoscopy, and it doesn't matter - within
reason - where you go to have it done. You've got to assume that
anyone who would get into the business of giving you the business
this way is going to be committed to doing a good job. I think pride
of performance would have to be big for a colonoscopaedist, or whatever
they're called, in order to permit him (or her) to transcend the
nitty-gritty of the work.
As will be obvious to any American who has had anything to do with
the American health care system, it's not easy to pin the cost down.
It turns out there are lots of different prices when someone sets
out to take this particular Incredible Journey.
If the insurance company covers it, it costs me nothing, or maybe
$50 just for irritation's sake.
If insurance won't cover it - because it is a screening test - it
will cost roughly $5,407.85 at Martha's Vineyard Hospital, give
or take a biopsy forceps or two. That's right out of my pocket.
Breathtaking, isn't it, and I'm not even afflicted, except with
an urge to flee.
Tim Walsh, the hospital chief, explains that private insurers will
pay about 55 percent of the hospital charges, or a little more than
cost. Medicare, which covers about 40 percent of the hospital's
customers, will pay almost the same, but bad debt and free care,
about $4 million at the Vineyard hospital, may not be used to calculate
the hospital's cost for the procedure.
But wait, how about shifting venues to the Falmouth Hospital, just
45 minutes away by ferry, or my son could run me over in the outboard,
and on a lovely spring day wouldn't that be the way to sail into
surgery? In Falmouth, the price tag is $1,700 to $2,000, depending,
as the colonoscope-wielding surgeon's office manager put it, on
those forceps and serendipitous polyps perhaps. Or how about Cape
Cod Hospital? Also, about $2,000, and soon there'll be a fast ferry
to Hyannis. Depending on the deals those hospitals have made with
the private insurers or Medicare, they'll get a percentage of their
charges, something similar to what the Island hospital receives
perhaps.
Let's see. Nothing? $2,000? $5,407.85? What shall I choose?
Wait a minute. But I wanted to know, what does it cost. One yearns
to know. Not what can I pay, or not pay at all. What does it actually
cost to convene a highly educated team of investigators to travel
the reaches of one man's bowels in search of what no one wants to
find? It's a medical mystery.
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